Posts Tagged ‘Blood Clots’

By Barret Procyshyn.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

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By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy

The blood’s ability to clot is one of our most important healing mechanisms. Our blood clots after flesh wounds, nosebleeds, surgery and various other types of injury. Clotting or coagulation begins when a blood vessel is damaged. The blood vessel has sensors which initiate clotting factors when blood vessel damage occurs. It is a very complex process, which very simply, keeps us alive.

However; while our blood clots to help protect us; unnecessary clotting can cause damage and even death. Damaging blood clots are actually quite common.  You may have heard the warnings about birth control pills and high dose of hormone replacement causing an increased risk of clots. Anti-smoking campaigns make no secret that smoking increases the risk of clots. Billions of dollars have been spent researching Aspirin, Warfarin and new medications designed to prevent blood clots. Blood clots are a major contributor to the leading causes of death in our country. You may have also heard the terms DVT and Pulmonary Embolism.  

A deep venous thrombosis or DVT is a condition where a blood clot forms in a blood vessel deep inside the body. DVTs can form when blood movement slows in the veins. Risk factors include bed rest, smoking, fractures in the lower extremities, recent child birth, cancer, heart failure, obesity, recent surgery or blood cell problems. Hormones in significant doses have also been leaked to blood clots. Sitting for long periods of time, such as travelling, can also increase the risk of a DVT. A DVT most often occurs in the large veins in the thigh and lower leg.

A DVT is most common in adults over the age of sixty, but they can occur at any age. Symptoms of a DVT can vary. The clot will block blood flow, causing swelling and usually some type of leg pain. Commonly there is also redness, warmth or tenderness in the affected leg. There also may be pain in the leg when putting weight on the foot. However, some DVTs cause no symptoms.

A DVT should involve immediate medical attention. If the clot breaks off the vessel and travels through the bloodsteam it becomes an embolism. Embolisms are very serious because they can get stuck in the brain, lungs, heart or in small, yet important vessels.

A Pulmonary Embolism is a sudden blockage in the lung artery. PEs as they are called for short, are very serious because they can cause permanent damage in the lung, low oxygen levels in the blood and damage to the other organs in your body because of the low oxygen. Up to 30% of patients with a PE will die if left untreated. Most risk is during the first few hours of the PE.

Although rare, travellers are at an increased risk of DVT, due to long periods of immobility. During all types of travel it is a good idea to stay mobile. If seated, try stretching the calf and leg muscles every hour. Even wiggling the toes or pressing the soles of your feet on the floor will improve circulation. Stop at a gas station and walk around every couple of hours or if you are in a plane take a walk down the aisle. Travellers should also stay well hydrated, avoiding alcohol and caffeine.

Compression stockings are also a great idea if you are travelling, sitting for any extended periods of time or are at increased risk of DVTs. These are special socks which deliver a certain amount of compression at the ankle and up the leg. Compression stockings or TED stockings come in various styles, sizes and pressure gradients. Compression stockings should always be fitted properly, with proper measurements taken by a fitter. If you would like more information please speak to one of our certified fitters at the pharmacy.

There are also other ways to prevent DVTs. Quitting smoking and cutting salt intake decreases your risk. If you have problems with fluid retention in your legs try elevating your feet, wear compression stockings or talk to your doctor about possible treatment. If having certain types of surgeries you may also be prescribed medications to prevent blood clots.

As always if you have any questions or concerns about these or other products, ask your pharmacist. 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

What do you call a million lawyers at the bottom of the ocean?  A good start.  What happens when you give a lawyer Viagra?  He gets taller.  What is the difference between a wood tick and a lawyer?  A tick falls off you when you die.  What do you call a lawyer who doesn’t chase ambulances?  Retired.  I could go on.  At the risk of having all my esteemed colleagues in the legal profession stringing me up, I’d just like to say that certain members of their profession have done an excellent job of scaring women about their birth control pill.  In my opinion this fear of birth control pills is out of proportion with the actual risk.

We have had several inquiries at the pharmacy lately about the relatively new birth control pills Yaz and Yasmin.  The calls have come from patients, their mothers and their doctors.  All the calls have been about whether Yaz and Yasmin cause blot clots.  You see many lawyers in the United States are suing the makers of Yaz and Yasmin, Bayer.  You have probably seen their ads on American TV saying they can get you money from the drug company if you have taken Yaz or Yasmin sign up with their law firm.  Class action lawsuits have started up in Canada as well.

Then in January the CBC television show, Market Place, did an expose.  It was how the evil drug company was killing off young women for profit and how the medical establishment was covering it up.  That caused more scared women to phone the pharmacy.  So, are Yaz and Yasmin evil?  In my opinion, no.  But I am part of the evil medical establishment.

Yasmin and Yaz have been sold in Canada for about the last 6 years.  Yaz has the interesting distinction that a patient takes the active pill for 24 days, instead of the usual 21.  That can mean a shorter menstrual period.  Both Yaz and Yasmin were advertised as causing less weight gain, less acne and less PMS like symptoms.  Most birth control pills have an estrogen like component and a progestin.  Although their actions in the body are complicated, these two hormone like chemicals prevent a women from ovulating.  That means a woman on the pill won’t produce an egg once a month and so can’t get pregnant.  What makes Yaz and Yasmin different is the progestin in them.  It is called drospirenone.

Drospirenone is where the lawyers come in.  Two studies in Europe, one called the Dutch Mega Study and the other done in Denmark seemed to show that drospirenone caused more blood clots that other birth control pills.  So the lawyers have jumped all over this and started class action lawsuits.  The problem is there have been several large studies saying drospirenone is safe and large groups of experts like the Society of Obstetricians and Gynaecologists of Cananda (SOGC) say the negative drospirenone studies are flawed.

Now I am not making light of the women who have had blood clots on Yaz or Yasmin.  Blood clots in your legs or lungs are very serious.  They can be fatal.  But they are a possibility with any birth control pill.  Other risk factors for getting clots are age, cigarette smoking, immobility, obesity and pregnancy.  That is one of the reasons why we don’t want smokers over 35 on the pill.  The risk of clots in women who are not on the pill is 4-5/10,000 per women per year.  It goes up to 9-10/10,000 if a person is on ANY birth control pill.  You might think that is a small but scary number.  But you must put it in perspective.  Women have a clotting rate of 29/10,000 during pregnancy and that risk goes up to 300-400/10,000 immediately after they deliver their child.

The CBC television show Market Place interviewed a women who suffered a blood clot in her lung and the family of a woman who died of a blood clot in the lung.  These women were both on Yasmin.  Their stories were heart wrenching and I really felt badly for them and their families.  However, a heart wrenching story about an individual does not reverse the fact that the SOGC says drospirenone containing pills are not more risky than pills without drospirenone.  The person that Market Place interviewed that bothered me the most was a 15 year old girl who went on Yaz to control her PMS symptoms.  She started having stabbing pains.  Her mother was tearing up describing how her daughter was wasting away.  Finally on the mother’s insistence the doctors did an ultra sound and found the girl’s gall bladder had swollen from its usual walnut size to grapefruit size.  The gall bladder had to be removed and the girl was saved.  Then the announcer says there was no proof the Yaz caused the gall bladder to expand and their was no proof Yaz caused this problem any more often than any other birth control pill.  So why was this case even mentioned?  To me it seemed to be an attempt to smear Yaz.

Market Place did bring up some valid points.  Bayer and the company that owned Yaz and Yasmin before it quickly went from zero sales to the top spot in birth control market over a couple of years due to some slick advertising.  Bayer said things in its ads that it shouldn’t have.  Does Yaz or Yasmin prevent PMS?  They don’t have a Health Canada indication for preventing PMS.  That means that by Health Canada rules, Bayer can’t promote that use in its ads to patients or physicians.  So Bayer did break the rules.  But it is not quite the same as out and out lying about these effects to doctors like Market Place implied.

Drospirenone is chemically similar to the potassium sparing diuretic spironolactone.  Spironolactone gets rid of excess fluid, so it can reduce water retention.  An interesting effect of spironolactone is it can reduce the effects of testosterone.  We call this an anti-androgenic effect.  For that reason low dose spironolactone has been used to reduce acne in young women.  Spironolactone has been used to reduce the weight gain, water retention and breast tenderness associated with PMS in young women.  Since drospirenone has similar chemical properties, it is not unreasonable to expect it will have similar effects in some women.  But at this point these good effects of drospirenone are just theoretical benefits.  They haven’t been proven in large studies and Health Canada hasn’t granted Yaz or Yasmin an indication to treat PMS. 

Originally, I said I could go on, but under oath I would have to admit I’m out of lawyer jokes.  So, although I am an evil member of the medical establishment, I believe the Society of Obstetricians and Gynaecologist that Yaz and Yasmin are not more dangerous than other birth control pills.  But if you don’t believe me, go to the links below.  They are links to the Market Place episode and the SOGC Clinical Practice guidelines.  Look at them and send us your comments!

CBC Market Place segment: www.cbc.ca/marketplace/2011/spinningapill/

SOGC Guidelines on Birth Control Pills and Clots:  www.sogc.org/guidelines/documents/gui252CPG1012E.pdf

As always if you have any questions or concerns about these or other products, ask your pharmacist. 

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca